专家述评
ENGLISH ABSTRACT
关注OCT血管成像在新生血管性AMD长期治疗和随访中的临床指导作用
薄其玉
孙晓东
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20220617-00282
Critical guiding role of OCT angiography in long-term treatment and follow-up of neovascular AMD
Bo Qiyu
Sun Xiaodong
Authors Info & Affiliations
Bo Qiyu
National Clinical Research Center for Ophthalmic Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200080, China
Sun Xiaodong
National Clinical Research Center for Ophthalmic Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200080, China
·
DOI: 10.3760/cma.j.cn115989-20220617-00282
0
0
0
0
0
0
PDF下载
APP内阅读
摘要

新生血管性年龄相关性黄斑变性(nAMD)发病机制复杂,黄斑新生血管(MNV)是其关键致病因素,目前抗VEGF药物玻璃体腔注射是nAMD的主要治疗方法。近年来随着眼底影像技术不断发展,具有无创、快速、分层、高清功能的光相干断层扫描血流成像(OCTA)技术在nAMD的诊断、鉴别诊断、疾病动态监测及治疗随访方面呈现出强大的优势,临床医生对OCTA在nAMD等疾病诊断中的重要作用有了一定的认识,OCTA临床应用价值也在不断被认知,但目前对其在nAMD和息肉样脉络膜血管病变(PCV)患者治疗随访中的应用价值尚认识不足。我们通过对近年来OCTA研究大量相关文献的回顾,并结合本研究团队近年来采用OCTA对nAMD和PCV病程监测和治疗效果随访的临床实践,对相关疾病的病理机制产生了新的认识和理解。本文阐述了基于长期OCTA系列研究获得的对AMD诊疗价值的最新认知、AMD应用OCTA影像检查时的新发现及其对眼科临床实践的影响,展望了OCTA影像检查对nAMD复发和对抗VEGF治疗反应的预测作用,以及OCTA影像在nAMD治疗和随访方案制定和优化中的临床价值,希望临床医生关注并重视OCTA在AMD长期治疗监测和随访中的临床价值和指导作用。

光相干断层扫描;老年;黄斑变性/诊断;脉络膜新生血管/诊断;渗出;监测预测价值;血管内皮生长因子/抑制剂;光相干断层扫描血管成像
ABSTRACT

The pathogenesis of neovascular age-related macular degeneration (nAMD) is complex and macular neovascularization (MNV), a key pathogenic factor in nAMD, is prone to recurrence.Vitreous injection of anti-VEGF drugs is the main therapy of nAMD.In recent years, a lot of progress has been made in fundus imaging techniques and optical coherence tomography angiography (OCTA) with non-invasive, rapid, stratified and high-definition functions has shown strong advantages in diagnosis, differential diagnosis, disease dynamic monitoring and follow-up of nAMD.Clinicians have had a certain understanding of the important role of OCTA in the diagnosis of nAMD and other diseases, and its clinical application value has been recognized gradually.However, its application value in follow-up of patients with nAMD and polypoid choroidal vasculopathy (PCV) is still not well understood.By reviewing a large number of recent relevant literature on OCTA, and combining the clinical practice of our research team in monitoring the course of AMD and PCV disease by OCTA, we have gained new knowledge and understanding of the pathological mechanism of AMD and PCV.In this paper, we elucidated the latest understanding of the diagnostic value of OCTA in AMD based on long-term series of OCTA studies, the new findings of OCTA in AMD management of our team, as well as its impact on ophthalmology clinical practice.Then we forecasted the role of OCTA in the prediction of recurrence and anti-VEGF treatment response, as well as the clinical value of OCTA in the optimization of nAMD treatment and follow-up plan.It is recommended that clinicians pay more attention to the clinical value and guiding role of OCTA in long-term treatment monitoring and follow-up of AMD.

Tomography, optical coherence;Aged;Macular degeneration/diagnosis;Choroidal neovascularization/diagnosis;Exudates and transudates;Predictive value of tests;Vascular endothelial growth factor/antagonists & inhibitors;Optical coherence tomography angiography
Sun Xiaodong, Email: nc.defudabe.utjsnusdx
引用本文

薄其玉,孙晓东. 关注OCT血管成像在新生血管性AMD长期治疗和随访中的临床指导作用[J]. 中华实验眼科杂志,2022,40(07):604-608.

DOI:10.3760/cma.j.cn115989-20220617-00282

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价
新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,nAMD)是导致中老年人群不可逆性视力损害的关键原因,黄斑新生血管(macular neovascularization,MNV)形成是nAMD的主要病理机制。近年来,光相干断层扫描血流成像(optical coherence tomography angiography,OCTA)成为MNV清晰呈像有用工具。临床实践表明,OCTA可以帮助临床医师改善或合理选择临床观察方法,减少或不使用传统的荧光素眼底血管造影(fluorescein fundus angiography,FFA)对nAMD进行诊断、鉴别诊断或动态观察,以尽可能避免有创检查方法带来的潜在不良反应风险 [ 1 , 2 ]。实际上,OCTA在多种疾病临床实践中的作用和价值并非仅仅局限于诊断及鉴别诊断层面,基于其快捷、无创、直观成像的特点,OCTA在AMD动态观察和诊疗随访过程中的实用价值也值得被关注。然而,目前国内外公认的关于nAMD治疗及再治疗的判断标准中并未涉及OCTA相关指标,部分研究者认为,相较于光相干断层扫描(optical coherence tomography,OCT)影像,OCTA对nAMD的随访监测作用及指导意义似乎没有绝对优势。但是,我们对近年来大量关于OCTA的研究进展文献进行了复习,同时结合我们的相关研究和临床实践,发现OCTA在nAMD影像检查中的作用不容小觑,其在AMD的治疗和随访中的应用意义及前景值得临床眼科医生重视。
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
魏文斌曾司彦重视光相干断层扫描血流成像的临床应用及其图像的判读[J]. 中华实验眼科杂志 201735(10)∶865-870. DOI: 10.3760/cma.j.issn.2095-0160.2017.10.001 .
返回引文位置Google Scholar
百度学术
万方数据
Wei WB , Zeng SY . Paying attention to the clinical application and image interpretation in optical coherence tomography angiography[J]. Chin J Exp Ophthalmol 201735(10)∶865-870. DOI: 10.3760/cma.j.issn.2095-0160.2017.10.001 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[2]
王敏周瑶正确认识OCT血管成像技术的临床应用价值[J]. 中华实验眼科杂志 201634(12)∶1057-1060. DOI: 10.3760/cma.j.issn.2095-0160.2016.12.001 .
返回引文位置Google Scholar
百度学术
万方数据
Wang M , Zhou Y Correctly understanding the clinical value of optical coherence tomography angiography[J]. Chin J Exp Ophthalmol 201634(12)∶1057-1060. DOI: 10.3760/cma.j.issn.2095-0160.2016.12.001 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[3]
de Oliveira Dias JR , Zhang Q , Garcia J et al. Natural history of subclinical neovascularization in nonexudative age-related macular degeneration using swept-source OCT angiography[J]. Ophthalmology 2018125(2)∶255-266. DOI: 10.1016/j.ophtha.2017.08.030 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Carnevali A , Cicinelli MV , Capuano V et al. Optical coherence tomography angiography:a useful tool for diagnosis of treatment-naïve quiescent choroidal neovascularization[J]. Am J Ophthalmol 2016169189-198. DOI: 10.1016/j.ajo.2016.06.042 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Roisman L , Zhang Q , Wang RK et al. Optical coherence tomography angiography of asymptomatic neovascularization in intermediate age-related macular degeneration[J]. Ophthalmology 2016123(6)∶1309-1319. DOI: 10.1016/j.ophtha.2016.01.044 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Capuano V , Miere A , Querques L et al. Treatment-naïve quiescent choroidal neovascularization in geographic atrophy secondary to nonexudative age-related macular degeneration[J]. Am J Ophthalmol 201718245-55. DOI: 10.1016/j.ajo.2017.07.009 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Yang J , Zhang Q , Motulsky EH et al. Two-year risk of exudation in eyes with nonexudative age-related macular degeneration and subclinical neovascularization detected with swept source optical coherence tomography angiography[J]. Am J Ophthalmol 20192081-11. DOI: 10.1016/j.ajo.2019.06.017 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
陈有信汤加抗血管内皮生长因子治疗眼部新生血管性疾病问题与挑战[J]. 中华实验眼科杂志 201937(1)∶1-4. DOI: 10.3760/cma.j.issn.2095-0160.2019.01.001 .
返回引文位置Google Scholar
百度学术
万方数据
Chen YX , Tang J Problems and challenges of anti-vascular endothelial growth factor therapy for ocular neovescularizat ion diseases [J]. Chin J Exp Ophthalmol 201937(1)∶1-4. DOI: 10.3760/cma.j.issn.2095-0160.2019.01.001 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[9]
Heier JS , Brown DM , Shah SP et al. Intravitreal aflibercept injection vs sham as prophylaxis against conversion to exudative age-related macular degeneration in high-risk eyes:a randomized clinical trial[J]. JAMA Ophthalmol 2021139(5)∶542-547. DOI: 10.1001/jamaophthalmol.2021.0221 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Chan CK , Lalezary M , Abraham P et al. Prophylactic ranibizumab to prevent neovascular age-related macular degeneration in vulnerable fellow eyes:a randomized clinical trial[J]. Ophthalmol R etina 20226(6)∶484-494. DOI: 10.1016/j.oret.2022.01.019 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Yannuzzi LA , Sorenson J , Spaide RF et al. Idiopathic polypoidal choroidal vasculopathy (IPCV)[J]. Retina 199010(1)∶1-8.
返回引文位置Google Scholar
百度学术
万方数据
[12]
Dansingani KK , Gal-Or O , Sadda SR et al. Understanding aneurysmal type 1 neovascularization (polypoidal choroidal vasculopathy)∶a lesson in the taxonomy of ' expanded spectra’-a review [J]. Clin Exp Ophthalmol 201846(2)∶189-200. DOI: 10.1111/ceo.13114 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
黎晓新石璇认识光相干断层扫描血管成像技术特色,提升光相干断层扫描血管成像技术临床应用水平[J]. 中华眼底病杂志 201733(1)∶3-6. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.002 .
返回引文位置Google Scholar
百度学术
万方数据
Li XX , Shi X Clinical applications of optical coherence tomography angiography[J]. Chin J Ocul Fundus Dis 201733(1)∶3-6. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.002 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[14]
Bo Q , Yan Q , Shen M et al. Appearance of polypoidal lesions in patients with polypoidal choroidal vasculopathy using swept-source optical coherence tomographic angiography[J]. JAMA Ophthalmol 2019137(6)∶642-650. DOI: 10.1001/jamaophthalmol.2019.0449 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Cheung C , Lai T , Teo K et al. Polypoidal choroidal vasculopathy:consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup[J]. Ophthalmology 2021128(3)∶443-452. DOI: 10.1016/j.ophtha.2020.08.006 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Serra R , Coscas F , Pinna A et al. Fractal analysis of polypoidal choroidal neovascularisation in age-related macular degeneration[J]. Br J Ophthalmol 2021105(10)∶1421-1426. DOI: 10.1136/bjophthalmol-2020-317011 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Laíns I , Wang JC , Cui Y et al. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)[J]. Prog Retin Eye Res 202184100951. DOI: 10.1016/j.preteyeres.2021.100951 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Fujita A , Kataoka K , Takeuchi J et al. Diagnostic characteristics of polypoidal choroidal vasculopathy based on B-scan swept-source optical coherence tomography angiography and its interrater agreement compared with indocyanine green angiography[J]. Retina 202040(12)∶2296-2303. DOI: 10.1097/IAE.0000000000002760 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Wang Y , Bo Q , Jia H et al. Small dome-shaped pigment epithelium detachment in polypoidal choroidal vasculopathy:an under-recognized sign of polypoidal lesions on optical coherence tomography?[J]. Eye (Lond) 202236(4)∶733-741. DOI: 10.1038/s41433-020-01390-0 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Brown DM , Kaiser PK , Michels M et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration[J]. N Engl J Med 2006355(14)∶1432-1444. DOI: 10.1056/NEJMoa062655 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Rosenfeld PJ , Brown DM , Heier JS et al. Ranibizumab for neovascular age-related macular degeneration[J]. N Engl J Med 2006355(14)∶1419-1431. DOI: 10.1056/NEJMoa054481 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Lalwani GA , Rosenfeld PJ , Fung AE et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration:year 2 of the PrONTO Study[J]. Am J Ophthalmol 2009148(1)∶43-58. DOI: 10.1016/j.ajo.2009.01.024 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Chakravarthy U , Harding SP , Rogers CA et al. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation:2-year findings of the IVAN randomised controlled trial[J]. Lancet 2013382(9900)∶1258-1267. DOI: 10.1016/S0140-6736(13)61501-9 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Schmidt-Erfurth U , Waldstein SM . A paradigm shift in imaging biomarkers in neovascular age-related macular degeneration[J]. Prog Retin Eye Res 2016501-24. DOI: 10.1016/j.preteyeres.2015.07.007 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
阿柏西普玻璃体内注射治疗新生血管性年龄相关性黄斑变性的治疗-延长方案中国共识专家组采用治疗-延长方案进行阿柏西普玻璃体内注射治疗新生血管性年龄相关性黄斑变性专家共识(2021版)[J]. 中华实验眼科杂志 202139(7)∶577-584. DOI: 10.3760/cma.j.cn115989-20210311-00162 .
返回引文位置Google Scholar
百度学术
万方数据
Treat-and-Extend Regimen for Management of Neovascular Age-related Macular Degeneration Chinese Experts Consensus Group. Chinese experts consensus of treat-and-extend regimen for management of neovascular age-related macular degeneration by intravitreal injection of aflibercept (2021)[J]. Chin J Exp Ophthalmol 202139(7)∶577-584. DOI: 10.3760/cma.j.cn115989-20210311-00162 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[26]
Choi M , Kim SW , Yun C et al. OCT angiography features of neovascularization as predictive factors for frequent recurrence in age-related macular degeneration[J]. Am J Ophthalmol 2020213:109-119. DOI: 10.1016/j.ajo.2020.01.012 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Al-Sheikh M , Iafe NA , Phasukkijwatana N et al. Biomarkers of neovascular activity in age-related macular degeneration using optical coherence tomography angiography[J]. Retina 201838(2)∶220-230. DOI: 10.1097/IAE.0000000000001628 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Oishi A , Mandai M , Kimakura M et al. Characteristics of fine vascular network pattern associated with recurrence of polypoidal choroidal vasculopathy[J]. Eye (Lond) 201125(8)∶1020-1026. DOI: 10.1038/eye.2011.110 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Hikichi T . Six-year outcomes of antivascular endothelial growth factor monotherapy for polypoidal choroidal vasculopathy [J]. Br J Ophthalmol 2018102(1)∶97-101. DOI: 10.1136/bjophthalmol-2017-310448 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Yang J , Yuan M , Wang E et al. Five-year real-world outcomes of anti-vascular endothelial growth factor monotherapy versus combination therapy for polypoidal choroidal vasculopathy in a Chinese population:a retrospective study[J]. BMC Ophthalmol 201919(1)∶237. DOI: 10.1186/s12886-019-1245-4 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Wakazono T , Yamashiro K , Oishi A et al. Recurrence of choroidal neovascularization lesion activity after aflibercept treatment for age-related macular degeneration[J]. Retina 201737(11)∶2062-2068. DOI: 10.1097/IAE.0000000000001451 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Kwon HJ , Lee JJ , Park SW et al. Enlargement of polypoidal choroidal vasculopathy lesion without exudative findings assessed in en face optical coherence tomography images [J]. Graefe ' s Arch Clin Exp Ophthalmol 2019257(8)∶1621-1629. DOI: 10.1007/s00417-019-04317-y .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Coscas F , Lupidi M , Boulet JF et al. Optical coherence tomography angiography in exudative age-related macular degeneration:a predictive model for treatment decisions[J]. Br J Ophthalmol 2019103(9)∶1342-1346. DOI: 10.1136/bjophthalmol-2018-313065 .
返回引文位置Google Scholar
百度学术
万方数据
[34]
Roberts PK , Nesper PL , Gill MK et al. Semiautomated quantitative approach to characterize treatment response in neovascular age-related macular degeneration:a real-world study[J]. Retina 201737(8)∶1492-1498. DOI: 10.1097/IAE.0000000000001400 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Miere A , Semoun O , Cohen SY et al. Optical coherence tomography angiography features of subretinal fibrosis in age-related macular degeneration[J]. Retina 201535(11)∶2275-2284. DOI: 10.1097/IAE.0000000000000819 .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Yang S , Li T , Jia H et al. Targeting C3b/C4b and VEGF with a bispecific fusion protein optimized for neovascular age-related macular degeneration therapy[J/OL]. Sci Transl Med 202214(647)∶eabj2177[2022-02-16]. http://www.ncbi.nlm.nih.gov/pubmed/35648811. DOI: 10.1126/scitranslmed.abj2177 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
孙晓东,Email: nc.defudabe.utjsnusdx
B
所有作者均声明不存在利益冲突
C
国家自然科学基金面上项目 (82171076)
上海申康医院发展中心重大临床研究项目 (SHDC2020CR2040B、SHDC2020CR5014)
评论 (0条)
注册
登录
时间排序
暂无评论,发表第一条评论抢沙发
MedAI助手(体验版)
文档即答
智问智答
机器翻译
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。
生成快照
文献快照

你好,我可以帮助您更好的了解本文,请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持:

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号